Elevator for directing medical tool

ABSTRACT

There is provided herein an endoscope assembly comprising at least one front-pointing viewing element on a front end of a distal section of the endoscope assembly, at least one side-looking viewing element on at least one side wall of the distal section of the endoscope assembly, a working channel configured for insertion of a medical tool towards the distal section, and a system for regulating the direction of exit of medical device wherein said system enables the medical device to exit at multiple angles to the long dimension of the endoscope device either from the front end or through side walls of the distal section of the device.

CROSS-REFERENCE

The present specification relies on, for priority, U.S. ProvisionalPatent Application No. 61/988,084, entitled “Elevator for DirectingMedical Tool”, and filed on

May 2, 2014, herein incorporated by reference in its entirety.

FIELD

The present specification generally relates to multiple viewing elementendoscopes and, in particular, describes a multiple viewing elementendoscope assembly comprising an elevator mechanism that enables amedical tool to exit from one of a plurality of openings, or workingchannels, present in the fields of view of at least one of the multipleviewing elements.

BACKGROUND

Endoscopes have attained great acceptance within the medical community,since they provide a means for performing procedures with minimalpatient trauma, while enabling the physician to view the internalanatomy of the patient. Over the years, numerous endoscopes have beendeveloped and categorized according to specific applications, such ascystoscopy, colonoscopy, laparoscopy, upper GI endoscopy and others.Endoscopes may be inserted into the body's natural orifices or throughan incision in the skin.

An endoscope is usually an elongated tubular shaft, rigid or flexible,having one or more video cameras or fiber optic lens assemblies at itsdistal end. The shaft is connected to a handle, which sometimes includesan ocular for direct viewing. Viewing is also usually possible via anexternal screen. Various surgical tools may be inserted through aworking channel in the endoscope to perform different surgicalprocedures.

Endoscopes generally have at least a front viewing element andoptionally a side viewing element to view the internal organ, such asthe colon, illuminators associated with each viewing element, one ormore fluid injectors to clean the lens assembly of the viewingelement(s), and a working channel to insert surgical tools, for example,to remove polyps found in the colon. Typically, endoscopes also havefluid injectors (“jet”) to clean a body cavity, such as the colon, intowhich they are inserted. The illuminators commonly used are fiber opticswhich transmit light, generated remotely, to the endoscope tip section.The use of light-emitting diodes (LEDs) for illumination is also known.

Often surgical tools inserted through a working channel exit from aworking channel opening at the front of the distal end of the endoscopetip. The front viewing element allows for the operator to view the toolwithin the patient's body. In other configurations, surgical toolsinserted through a working channel exit from a working channel openingpositioned on a side, near the distal end, of the endoscope tip.

Currently available endoscope assemblies do not adequately address theneed to exit a surgical tool inserted through the working channel, fromeither the front opening or one or more side openings located on thedistal end of the endoscope tip. Hence there are limitations on thevisibility of the body cavity as well as on the ability to reach thecavity and operate on polyps or lesions on the cavity's walls.

U.S. Pat. No. 7,537,561 titled “Endoscope Apparatus” invented by Yamayaet al. describes “an endoscope apparatus comprising: an insertionportion having first and second channels arranged therein andterminating at first and second openings, respectively, at a distalportion of the insertion portion; an observation optical system forcapturing an observation image, which is arranged to the insertionportion; a first treatment-tool oscillating base which guides, in afirst direction and centering around a first rotating shaft, a firsttreatment-tool inserted via the first channel arranged to the insertionportion, a range of oscillation of the first treatment-tool by the firsttreatment-tool oscillating base being set so as to cause a distal end ofthe first treatment-tool to be selectively positioned inside or outsidethe observation image; and a second treatment-tool oscillating basewhich guides, in a second direction which is different from the firstdirection and centering around a second rotating shaft, a secondtreatment-tool inserted via the second channel arranged in the insertionportion, the second rotating shaft being positioned closer to the distalportion side of the insertion portion than the first rotating shaft.”However, such assemblies with a front-pointing camera with front workingchannel openings to treat (removing/biopsying) polyps or lesions foundon the side walls of the colon need to be retracted and repositionedwith their front facing the polyp or lesion. This re-positioning of thetip may result in “losing” the polyp/lesion and further effort and timemust be invested in re-locating it.

Thus there is a need in the art for an endoscope assembly that allows amedical tool to exit the working channel from the front as well as theside of an endoscope tip, and which may be viewed by corresponding frontand side viewing elements.

SUMMARY

The following embodiments and aspects thereof are described andillustrated in conjunction with systems, tools and methods, which aremeant to be exemplary and illustrative, not limiting in scope.

The present specification discloses an endoscope assembly, the assemblycomprising: at least one front-pointing viewing element on a front endof a distal section of the endoscope assembly; at least one side-lookingviewing element on at least one side wall of the distal section of theendoscope assembly; a working channel configured for insertion of amedical tool towards the distal section; and an elevator for directingthe medical tool to exit from the working channel in a direction thatcan be viewed by one of the at least one front-pointing viewing elementand the at least one side-looking viewing element.

Optionally, the working channel comprises: a front channel opening onthe front end; and a side channel opening on each of the at least oneside wall, wherein the front channel opening and the side channelopening allow the medical tool to exit the working channel.

Optionally, the elevator further comprises: a first curvilinear sectionand a second curvilinear section wherein an edge of the first section isconnected to an edge of the second section forming a substantiallyV-shaped groove for receiving and guiding a medical tool to either thefront channel opening or side channel opening; and, a pivot, wherein thepivot enables controlling of the elevator.

The assembly may comprise one side-looking viewing element.

The assembly may comprise two side-looking viewing elements. Theside-looking viewing elements may be directed to opposing sides. Anoptical axis of each side-looking viewing element may be perpendicularto an optical axis of the front-pointing viewing element. An opticalaxis of each side-looking viewing element may form an obtuse angle withan optical axis of the front-pointing viewing element. An optical axisof each side-looking viewing element may form an acute angle with anoptical axis of the front-pointing viewing element.

The present specification also discloses an endoscope assembly having adistal tip section, the assembly comprising: at least one front-pointingviewing element on a front wall of the distal tip section; at least oneside-pointing viewing element on at least one side wall of the distaltip section; a working channel configured for insertion of a medicaltool into and through the distal tip section, wherein said workingchannel provides a first exit for said medical tool, said first exitcomprising a first opening in the front wall of the distal tip section,and a second exit for said medical tool, said second exit comprising asecond opening in the at least one side wall of the distal tip section;a ramp structure, wherein a portion of said ramp structure is positionedproximal to said second exit within said working channel, therebypositioning said second exit between the first exit and the portion ofthe ramp structure, wherein said ramp structure is coupled to aninternal wall of the distal tip section via a pivot and wherein aposition of the ramp structure may be modified to regulate a directionof exit of the medical tool; and a control system coupled to said pivot,wherein said control system is configured to modify a position of saidramp structure to regulate the direction of exit of the said medicaldevice.

The ramp may be adapted to be positioned in at least two differentangles relative to the internal wall of the distal tip section.

Optionally, the ramp structure comprises partially raised walls on sideedges which are configured to hold and guide an elongated surface of themedical tool.

The pivot may comprise at least one of pivot hinge joint, pivot ball andsocket joint, pivot pin and hole joint.

Optionally, the control system comprises a control wire coupled to thepivot at a first end and to a control knob positioned on a handlesection of the endoscope assembly at a second end.

The control system may comprise an electronic controller.

When said pivot is in a first position, the ramp structure may bepositioned to enable the medical tool to exit from the first exit of thedistal tip section. Additionally, when said pivot direction is in afirst position, said medical tool may exit from the front wall of thedistal tip section at an angle of substantially zero degrees relative tothe long dimension towards the front portion of the endoscope device.

When said pivot direction is in a second position, the ramp structuremay be configured to receive and bend the medical tool to enable it toexit from the second exit. Additionally, when said pivot direction is ina second position, said medical tool may exit from the second exit at anangle of approximately 90 degrees relative to the long dimension towardsthe front portion of the endoscope device.

Optionally, said ramp structure further comprises a first curvilinearsection and a second curvilinear section wherein an edge of the firstsection is connected to an edge of the second section forming a groovefor receiving and guiding a medical tool to either the first exit or thesecond exit.

The present specification also discloses an endoscope assembly having adistal tip section, the assembly comprising: at least one front-pointingviewing element on a front wall of the distal tip section; at least oneside-pointing viewing element on a side wall of the distal tip section;a working channel configured for insertion of a medical tool into andthrough the distal tip section, wherein said working channel provides afirst exit for said medical tool, said first exit comprising a firstopening in the front wall of the distal tip section, and a second exitfor said medical tool, said second exit comprising a second opening inthe at least one side wall of the distal tip section, wherein said firstexit and second exit are separated by a distance of 7 mm to 11 mm; aramp structure, wherein said ramp structure is coupled to an internalwall of the distal tip section via a pivot, wherein a position of theramp structure may be modified to regulate a direction of exit of themedical tool, and wherein said pivot is positioned at least 0.3 mmproximal to the second exit within said working channel, thereby placingsaid second exit between the first exit and the pivot; and a controlsystem configured to modify a position of said ramp structure toregulate the direction of exit of the said medical device, wherein saidcontrol system comprises a control wire coupled to the pivot at a firstend and to a control knob positioned on a handle section of theendoscope assembly at a second end.

The ramp may be adapted to be positioned in at least two differentangles relative to the internal wall of the distal tip section.

Optionally, the ramp structure comprises partially raised walls on sideedges which are configured to hold and guide an elongated surface of themedical tool.

When said pivot is in a first position, the ramp structure may bepositioned to enable the medical tool to exit from the first exit of thedistal tip section. Additionally, when said pivot direction is in afirst position, said medical tool may exit from the front wall of thedistal tip section parallel to the long dimension towards the frontportion of the endoscope device.

When said pivot direction is in a second position, the ramp structuremay be configured to receive and bend the medical tool to enable it toexit from the second exit. Additionally, when said pivot direction is ina second position, said medical tool may exit from the second exit at anangle of approximately 90 degrees relative to a long dimension towardsthe front portion of the endoscope device.

Optionally, said ramp structure further comprises a first curvilinearsection and a second curvilinear section wherein an edge of the firstsection is connected to an edge of the second section forming a groovefor receiving and guiding a medical tool to either the first exit or thesecond exit.

The present specification also discloses an endoscope assembly having adistal tip section, the assembly comprising: at least one front-pointingviewing element on a front wall of the distal tip section; at least oneside-pointing viewing element on a side wall of the distal tip section;a working channel configured for insertion of a medical tool into andthrough the distal tip section, wherein said working channel provides afirst exit for said medical tool, said first exit comprising a firstopening in the front wall of the distal tip section, and a second exitfor said medical tool, said second exit comprising a second opening inthe at least one side wall of the distal tip section, wherein said firstexit and second exit are separated by a distance of 7 mm to 11 mm; aramp structure having a distal end and a proximal end with a pivotpoint, wherein said ramp structure is coupled to an internal wall of thedistal tip section via the pivot point, wherein a position of the rampstructure may be modified to regulate a direction of exit of the medicaltool, and wherein said distal end of the ramp structure is positioned atleast 0.3 mm proximal to the second exit within said working channel,thereby placing said second exit between the first exit and the distalend of the ramp structure; and a control system configured to modify aposition of said ramp structure to regulate the direction of exit of thesaid medical device, wherein said control system comprises a controlwire coupled to the pivot at a first end and to a control knobpositioned on a handle section of the endoscope assembly at a secondend.

The aforementioned and other embodiments of the present invention shallbe described in greater depth in the drawings and detailed descriptionprovided below.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention will beappreciated, as they become better understood by reference to thefollowing detailed description when considered in connection with theaccompanying drawings, wherein:

FIG. 1 shows an exploded view of a tip section of an endoscope assemblyaccording to some embodiments;

FIG. 2A shows an alternate view of a tip section of an endoscopeassembly according to some embodiments;

FIG. 2B shows another view of a tip section of an endoscope assemblyaccording to some embodiments;

FIG. 3A illustrates a cross-sectional view of a tip section of anendoscope assembly according to some embodiments;

FIG. 3B shows a another view of the tip section according to someembodiments;

FIG. 4 illustrates a medical tool guided by a ramp to exit a frontchannel opening in the tip section according to some embodiments;

FIG. 5A illustrates an alternative position of a ramp, in accordancewith an embodiment;

FIG. 5B illustrates an another view of an alternative position of a rampshown in FIG. 5a, in accordance with an embodiment;

FIG. 6 illustrates a medical tool guided by a ramp to exit a sidechannel opening in the tip section according to some embodiments; and,

FIG. 7 illustrates a control system to regulate the position oframp/elevator in accordance with an embodiment.

DETAILED DESCRIPTION OF THE INVENTION

The present specification is directed towards multiple embodiments. Thefollowing disclosure is provided in order to enable a person havingordinary skill in the art to practice the invention. Language used inthis specification should not be interpreted as a general disavowal ofany one specific embodiment or used to limit the claims beyond themeaning of the terms used therein. The general principles defined hereinmay be applied to other embodiments and applications without departingfrom the spirit and scope of the invention. Also, the terminology andphraseology used is for the purpose of describing exemplary embodimentsand should not be considered limiting. Thus, the present invention is tobe accorded the widest scope encompassing numerous alternatives,modifications and equivalents consistent with the principles andfeatures disclosed. For purpose of clarity, details relating totechnical material that is known in the technical fields related to theinvention have not been described in detail so as not to unnecessarilyobscure the present invention.

Reference is now made to FIG. 1, which shows an exploded view of a tipsection 200 of an endoscope assembly 100. It is noted that the term“endoscope” as mentioned to herein may refer particularly to aduodenoscope or colonoscope, according to some embodiments, but is notlimited only to duodenoscopes or colonoscopes. The term “endoscope” mayrefer to any instrument used to capture images of, and visualize, theinterior of a hollow organ or cavity of the body.

As shown in FIG. 1, the tip section 200 is turnable by way of flexibleshaft (not shown), which may also be referred to as a bending section,for example a vertebra mechanism. According to an embodiment, tipsection 200 of an endoscope includes a tip cover 300, an electroniccircuit board assembly 400 and a fluid channeling component 600.

The electronic circuit board assembly 400 is configured to carry a frontpointing viewing element 116 and two side looking viewing elements suchas viewing element 116 b on one side and another viewing element on theside opposite to one carrying the viewing element 116 b, which may besimilar to front pointing viewing element 116 and may include a ChargeCoupled Device (CCD) or a Complementary Metal Oxide Semiconductor (CMOS)image sensor.

The electronic circuit board assembly 400 is also configured to carryfront illuminators 240 a, 240 b, 240 c, which are associated with frontpointing viewing element 116, and are positioned to illuminate its fieldof view. In addition, the electronic circuit board assembly 400 isconfigured to carry side illuminators 250 a and 250 b, which areassociated with side looking viewing element 116 b, and are positionedto illuminate its field of view. Electronic circuit board assembly 400is also configured to carry side illuminators associated with sidelooking viewing element opposing side looking viewing element (116 b),which may be similar to side illuminators 250 a and 250 b.

In an embodiment, the front illuminators 240 a, 240 b, 240 c and sideilluminators 250 a and 250 b are discrete illuminators and include alight-emitting diode (LED), which may be a white light LED, an infraredlight LED, a near infrared light LED, an ultraviolet light LED or anyother LED. The term “discrete”, concerning discrete illuminator, refersto an illumination source, which generates light internally—in contrastto a non-discrete illuminator, which may be, for example, a fiber opticmerely transmitting light generated remotely.

Reference is now made to FIG. 1 along with FIGS. 2A and 2B, which showsalternate views of the tip section 200. According to some embodiments,fluid channeling component 600 includes a proximal fluid channelingsection 602 (or base) which has an cylindrical shape and a unitarydistal channeling section 604 (or elongated housing). Distal fluidchanneling section 604 partially continues the cylindrical shape ofproximal fluid channeling section 602 and has a shape of a partialcylinder (optionally elongated partial cylinder). In an embodiment, thefluid channeling component 600 comprises a front working channel 640having an entry point 640 a (Refer FIG. 2B) and a side working channel650 having an entry point 650 a (Refer FIG. 2B). The entry points 640 aand 650 a are located on the rear side of the fluid channeling component600 of the tip section 200 as illustrated in FIG. 2B.

The tip cover 300 is configured to fit over the inner modules of tipsection 200 including electronic circuit board assembly 400 and fluidchanneling component 600 and to provide protection to the internalcomponents housed within the inner modules. The opening 340 on the tipcover 300 provides an exit point for the front working channel 640 andthe opening 350 on the tip cover 300 provides an exit point for the sideworking channel 650. Further, the tip cover 300 includes a front panel320 having a front optical assembly 256, of front looking viewingelement 116. Front optical assembly 256 includes a plurality of lenses,static or movable, which provide a field of view of 90 degrees or more,120 degrees or more or up to essentially 180 degrees.

Optical axis of front looking viewing element 116 is essentiallydirected along the long dimension of the endoscope. However, inembodiments, since front looking viewing element 116 is a wide anglecamera, its field of view may include viewing directions at large anglesto its optical axis. Additionally, in an embodiment, the front panel 320includes optical windows 242 a, 242 b, and 242 c which cover theilluminators 240 a, 240 b and 240 c, respectively. It should be notedthat number of illumination sources used for illumination of the fieldof view might vary. In addition, the front panel 320 includes a workingchannel opening 340 of a working channel 640, which is further discussedbelow.

In another configuration, a jet channel opening 344 of jet channel 644is located on front panel 320 of tip cover 300. Jet channel 644 isconfigured to provide high-pressure jet of fluid such as water or salinefor cleaning the walls of the body cavity in an embodiment.

Also located on front panel 320 of tip cover 300 is injector opening 346of injector channel 646 having a nozzle 348 aimed at front opticalassembly 256. Injector channel 646 is configured for injecting fluid(liquid and/or gas) to wash contaminants such as blood, feces and otherdebris from front optical assembly 256 of front looking viewing element116. Optionally, injector channel 646 may be configured for cleaningfront optical assembly 256 and one, two, or all of optical windows 242a, 242 b, and 242 c. Visible on sidewall 362 of tip cover 300 is sideoptical assembly 256 b for side looking viewing element 116 b, which maybe similar to front optical assembly 256 and optical windows 252 a and252 b of illuminators 250 a and 250 b. Also on sidewall 362 of tip cover300, on the opposing side to side optical assembly 256 b, is an opticalassembly (not shown) for side looking viewing element, and opticalwindows of the illuminators corresponding to side looking viewingelement. In an embodiment, the optical axis of side looking viewingelement 116 b is directed perpendicular to the long dimension of theendoscope. However, in embodiments, since side looking viewing element116 b is a wide angle camera, its field of view includes viewingdirections at large angles to its optical axis. In accordance with someembodiments, the side looking viewing element 116 b has a field of viewof 90 degrees or more, 120 degrees or more or up to essentially 180degrees. In embodiments, optical axis of each side-looking viewingelement (116 b and the opposing viewing element) is perpendicular tooptical axis of front-pointing viewing element 116. In alternativeembodiments, optical axis of each side-looking viewing element forms anobtuse angle with optical axis of front-pointing viewing element 116. Inother embodiments, optical axis of each side-looking viewing elementforms an acute angle with optical axis of front-pointing viewing element116.

In addition, in an embodiment, the side injector opening 266 of sideinjector channel 666 is located at distal end of sidewall 362. A nozzlecover 267 is configured to fit side injector opening 266.

Additionally, in an embodiment, nozzle cover 267 includes a nozzle 268which is aimed at side optical assembly 256 b and is configured toinject fluid to wash contaminants such as blood, feces, and other debrisfrom side optical assembly 256 b of side looking viewing element 116 b.The fluid may include gas that is used for inflating a body cavity.Optionally, nozzle 268 is configured to clean both side optical assembly256 b and optical windows 252 a and/or 252 b.

According to some embodiments, side injector channel 666 is configuredto supply fluids to clean any of the tip elements (such as any opticalassembly, windows, illuminators, and other elements).

Although the tip section 200 is presented herein showing one sidethereof, it is noted that according to some embodiments, the opposingside may include elements similar to the side elements described herein(for example, side looking viewing element, side optical assembly,injector(s), nozzle(s), illuminator(s), window(s), opening(s) and otherelements).

It is noted that according to some embodiments, tip section 200 includesmore than one side looking viewing elements. In this case, the sidelooking viewing elements are installed such that their field of viewsare substantially opposing. Front-pointing viewing element 116 is ableto detect objects of interest (such as a polyp or another pathology)which are directly in its field of view, while side looking viewingelements are configured to detect additional objects of interest thatare normally hidden from front-pointing viewing element 116. Once anobject of interest is detected, endoscope operator can insert a surgicaltool and remove, treat and/or extract a sample of the polyp or itsentirety for biopsy.

In some cases, objects of interest may only be visible through sidelooking viewing elements such as 116 b. In this case, it is beneficialfor the endoscope's operator to be able to use surgical tools, which canaccess the object of interest and perform surgical operations while theobject of interest is visible by such side looking viewing elements.

According to some embodiments, fluid channeling component 600 isconfigured as a separate component from electronic circuit boardassembly 400. This configuration is adapted to separate the fluidchannels and working channel 640, which are located in fluid channelingcomponent 600 from the sensitive electronic and optical parts that arepresent in electronic circuit board assembly 400.

In an embodiment, the tip cover 300 of the tip section 200 includes aside working channel opening 350 for the side working channel 650 asmentioned earlier. Side working channel opening 350 is configured toimprove the performance of the endoscope (particularly, thecolonoscope). Typically colonoscopes have only one working channelopening such as the opening 340 provided for front working channel 640,which opens at the front distal section of the colonoscope. Such frontworking channel is adapted for insertion of a surgical tool. Thephysician is required to perform all necessary medical procedures, suchas biopsy, polyp removal and other procedures, through the frontopening.

In addition, for treating (removing/biopsying) polyps or lesions foundon the side walls of the colon, tip sections that only have one or morefront working channels need to be retracted and repositioned with theirfront facing the polyp or lesion. This repositioning of the tip mayresult in “losing” the polyp/lesion and further effort and time must beinvested in relocating it. However, the configuration shown in FIG. 1describes an endoscope (such as colonoscope) having a front viewingelement and one or more side viewing elements which comprises, inaddition to the front working channel opening 340, a side workingchannel opening 350. The front working channel 640 is configured for theinsertion of medical tools that can exit from front working channelopening 340. Similarly the side working channel 650 is configured suchthat the medical tools inserted through it can exit from the sideworking channel opening 350.

While some objects of interest may be visible and/or accessible via theendoscope's front panel 320 (FIG. 1), some objects of interest may bemore visible via side looking viewing element 116 b and/or accessiblevia endoscope side working channel opening 350 of the side workingchannel 650. Allowing an exit from side working channel opening 350enables medical procedures to be performed from (or in proximity to) theside of tip section 200, while at the same time viewing the procedure byside looking viewing element 116 b. This substantially increases theperformance and accessibility of the endoscope. In an embodiment, thetip section of the endoscope assembly 200 comprises another workingchannel opening on the side opposite to that shown in FIG. 2A, whichallows the physicians to operate on polyps or lesions detected by sideviewing element present on the side opposite to side having the sidewall362.

As discussed in the configurations shown in FIGS. 1, 2A and 2B, theendoscope assemblies described here comprise multiple separate workingchannels to provide operational access to both the front portion andside portions of the device. It includes separate entry and exit pointsfor the front working channel 640 and the side working channel 650.

The present specification describes a novel system for providingoperational access to both the front portion and side portion of devicefrom a single working channel. In an embodiment, the presentspecification describes a system wherein the medical tools insertedthrough a single working channel can be diverted to exit through boththe front opening and side wall openings at multiple angles relative tothe long dimension of the device. In an embodiment, the presentspecification describes a system wherein the exit angle of the medicaltool is regulated with the help of an elevator/ramp mechanism which inan embodiment, is controlled by the physician.

Reference is now made to FIG. 3A and FIG. 3B which illustrate across-sectional view of the tip section 800 of an endoscope device inaccordance with an embodiment of the present specification. In anembodiment, the tip section 800 comprises a fluid channeling component810 that includes a proximal fluid channeling section 802 (or base) anda distal channeling section 804 (or elongated housing). In anembodiment, the distal fluid channeling section 804 partially continuesthe shape of proximal fluid channeling section 802 and in an embodimenthas a shape of a truncated partial cylinder.

In an embodiment of the present specification, the tip section 800comprises an electronic circuit board 850 coupled to the fluidchanneling component 810. The electronic circuit board assembly 850 isconfigured to carry a front pointing viewing element 816 and two sidelooking viewing elements such as viewing element 816 b on one side andanother viewing element on the side opposite to one carrying the viewingelement 816 b, which may be similar to front pointing viewing element816 and may include a Charge Coupled Device (CCD) or a ComplementaryMetal Oxide Semiconductor (CMOS) image sensor.

The electronic circuit board assembly 850 is also configured to carryfront illuminators 840 a, 840 b, 840 c, which are associated with frontpointing viewing element 816, and are positioned to illuminate its fieldof view. In addition, the electronic circuit board assembly 850 isconfigured to carry side illuminators 850 a and 850 b, which areassociated with side looking viewing element 816 b, and are positionedto illuminate its field of view. Electronic circuit board assembly 850is also configured to carry side illuminators associated with sidelooking viewing element opposing side looking viewing element (816 b),which may be similar to side illuminators 850 a and 850 b.

In an embodiment, the front illuminators 840 a, 840 b, 840 c and sideilluminators 850 a and 850 b are discrete illuminators and include alight-emitting diode (LED), which may be a white light LED, an infraredlight LED, a near infrared light LED, an ultraviolet light LED or anyother LED. The term “discrete”, concerning discrete illuminator, refersto an illumination source, which generates light internally—in contrastto a non-discrete illuminator, which may be, for example, a fiber opticmerely transmitting light generated remotely.

According to some embodiments, the proximal fluid channeling section 802comprises a working channel 840. Medical tools inserted in the workingchannel 840 from the rear portion (facing the physician) of the fluidchanneling component 810, can exit from opening 841 located within thefluid channeling section 802. As the medical tool exits from opening841, in an embodiment, the medical tool is subsequently allowed toeither travel in a straight line direction or the direction of medicaltool is diverted with help of an elevator/ramp structure 801.

In an embodiment, the ramp structure 801 comprises a first section 801 aand a second section 801 b wherein an edge of the first section 801 a isconnected to an edge of the second section 801 b forming a substantiallyangled structure, or V-shaped groove, 801 c for receiving and guiding amedical tool to the appropriate working channel opening. In embodiments,the shape of the groove may not be limited to a V-shape; and any othershape such as a hyperbola, square, or any other suitable shape, may beused to handle and guide the medical tool. In an embodiment, the firstsection 801 a of the ramp structure 801 comprises a planar structurethat is positioned substantially parallel to the inside wall 804 a ofthe fluid channeling component 810 and defines a plane that intersectswith the plane defining the base 817 of the electronic circuit board 850at a right angle. In another embodiment, the plane defined by the firstsection 801 a bisects the base 817 of the electronic circuit board 850at a right angle. In an embodiment, the second section 801 b comprises aplanar structure that is substantially parallel to the plane defined bythe base 817 of the electronic circuit board 850 and is positioned at aright angle to the first section 801 a and inside wall 804 a of thefluid channeling component 810.

One of ordinary skill in the art would appreciate that the abovedescribed configuration and positioning of the ramp structure 801 onlydefines its initial configuration in an embodiment and the position andrelative angular orientation of ramp 801 changes as the ramp is movedwith the help of a pivot to regulate the direction of medical tool whichis discussed in subsequent sections of the specification.

In an embodiment, the first section 801 a and second section 801 b havesubstantially curvilinear structures. In an embodiment, the rampstructure 801 is pivotally connected to the internal side 804a of thefluid channeling component 810. In an embodiment, a pivot is connectedto ramp 801 such that by controlling the position of pivot, one cancontrol the angle at which ramp 801 aligns with inner wall 804 a offluid channeling component 810, which in turn controls the direction inwhich the medical tool exits the endoscope assembly.

In an embodiment, the system is configured such that ramp structure 801can be positioned among seven different positions to provide sevendifferent exit directions to the medical tool inserted through theworking channel 840. In these seven positions, the ramp is inclined atan angle of 0 degree, 15 degree, 30 degree, 45 degree, 60 degree, 75degree and 90 degree to the long dimension of the endoscope, where eachdegree covers a range of +/− five degrees. Accordingly the medical toolexits at angles of zero degree, 15 degree, 30 degree, 45 degree, 60degree, 75 degree and 90 degree to the long dimension of the endoscopein these respective positions.

In an embodiment, slightly raised walls on the side edges of ramp 801are configured to hold and guide the elongated surface of the medicaltool passing over it in position during an endoscopic procedure. In anembodiment, the ramp 801 is positioned between front section 808 of thedistal channeling section 804 and the opening 841 of the working channel840, such that changing the position of the ramp guides the medical toolto exit either through the front panel or through an exit in a sidewallof the endoscope device. In embodiments, the ramp position can beregulated to enable the medical tool to exit at multiple angles fromboth the front panel and sidewall of the device. In an embodiment, theequipment manufacturer provides openings for exit of working channel onthe front panel and on sidewalls of the endoscope device and the rampposition is allowed to shift between a predefined positions such thatthe medical tool can exit from these existing openings on the device.

In embodiments, front-pointing viewing element 816, aided byilluminators 840 a, 840 b and 840 c, is configured to provide a view ofthe medical tool exiting through a front channel opening located on afront portion of the distal tip of the endoscope. Similarly, inembodiments, side-looking viewing element 816 b, aided by illuminators850 a and 850 b, is configured to provide a view of the medical toolwhen it exits through a side wall of the endoscope device.

In FIG. 3A, the pivot is in a first position such that the first section801 a of ramp 801 is in a plane parallel to the inner wall 804 a offluid channeling component 810. In an embodiment, a medical toolinserted through working channel 840 exits at zero degrees relative tothe long dimension towards the front portion of the device (illustratedin FIG. 4) through a front channel opening provided on the front panelof the device. In an another embodiment, the pivot is turned to raisethe ramp such that it guides the medical tool passing over in a way thatthe said medical tool bends and exits from one of the side channelopenings provided on the device. In an embodiment, the position of pivotis controlled such that the medical tool bends at 90 degrees(illustrated and described in context of FIGS. 5a, b , and 6) or lesswhen it exits a side channel opening provided on a side wall of theendoscope device. In embodiments, the pivot coupled to the ramp 801 iscontrolled by adding a control component such as a lever to a handle ofendoscope assembly. In an embodiment, the lever is placed between knobson the handle and the handle's body.

One of ordinary skill in the art would appreciate that FIG. 3A describesa tip section of the endoscope assembly without the external tip cover.In an embodiment, the tip section is covered by a tip cover such as thetip cover 300 described for endoscope assembly of FIG. 1. In anembodiment, the tip cover of the endoscope assembly described in FIG. 3Ahas at least one side channel opening positioned at an appropriateposition to provide an exit to the medical tool which is maneuvered withthe help of ramp structure 801 towards a side wall of the endoscope tipsection (as described in the FIGS. 6). One of ordinary skill in the artwould appreciate that the side working channel opening on such tip covercan be positioned at any convenient location as per the systemrequirement. In an embodiment, the side working channel opening islocated closer to the front portion of the tip section compared to theposition of viewing element 816 b on the side wall. In anotherembodiment, the side working channel opening and the viewing element 816b are located at same horizontal distance from the front portion of thedistal tip. In an embodiment, the viewing element 816 b is locatedcloser to the front portion of the tip section compared to the positionof side working channel opening.

In an embodiment, in order to ensure that the medical tools operatedthrough the side working channel are viewed properly, the side workingchannel opening is positioned such that the medical tools operatedthrough the side working channel opening are within the field of view ofa side viewing element such as the viewing element 816 b on the sidewallof endoscope.

In an embodiment, the side working channel opening is positioned on thecircumference of the endoscope at a distance of 7 to 11 millimeters,preferably 8.5 mm to 9.5 mm, and more preferably at 9 mm to 9.1millimeters, and any increments therein, from the surface of the tip,where the front working channel opening is located. Accordingly, theramp structure is positioned within the working channel proximal to theside channel exit at a distance of at least 7 mm from the front workingchannel exit, and more preferably 8 mm to 10 mm, or at least 0.3 mmproximal to the side working channel exit (i.e. closer to the endoscopehandle than the tip). In another embodiment comprising a slim endoscopehaving a smaller diameter, the side working channel is preferablypositioned on the circumference of the endoscope at a distance of8.7-8.9 mm from the surface of the tip. In all such cases, the workingchannel may have an inner diameter of 2.8 mm to 6.5 mm.

In other embodiments, the distal end of the ramp is located in theworking channel at least 0.3 mm proximal (closer to the handle) relativeto the side channel exit. In other embodiments, the pivot point of theramp is located in the working channel at least 0.3 mm proximal (closerto the handle) relative to the side channel exit. In other embodiments,the distal end of the ramp is located in the working channel a distanceof 0.3 mm to 10 mm proximal (closer to the handle) relative to the sidechannel exit. In other embodiments, the pivot point of the ramp islocated in the working channel a distance of 0.3 mm to 10 mm proximal(closer to the handle) relative to the side channel exit.

In embodiments, an operating wire is used to operate ramp 801 remotelyby rotating it in a desired direction. In an embodiment, the operatingwire extends from the ramp to the handle of endoscope assembly. Inembodiments, an additional knob or a button on the handle provides acontrol interface to a physician to control ramp 801. In variousembodiments, the control interface can be located on the handle, on amain control unit connected to the endoscope assembly, on a computerconnected to the endoscope assembly, or on any other external controlunit that may communicate with the operating wire.

FIG. 7 illustrates a control system to regulate the position oframp/elevator section in accordance with an embodiment of the presentspecification. As shown in FIG. 7, a ramp 801 comprises a verticalsection 801 a coupled to a pivot 820. In an embodiment, the pivot 820 iscoupled to a control knob 890 through a control wire 880. In anembodiment, the control knob 890 is located on the control handleportion of the endoscope assembly such that the user/physician canoperate the control knob 890 to regulate the position of ramp 801. Oneof ordinary skill in the art would appreciate that there could bemultiple ways to couple the control wire 880 with the pivot 820 suchthat on user instruction, the position of pivot can be changed which inturn can change the position of ramp 801. In embodiment, the endoscopeassembly comprises any of the conventional pivot joint systems to couplethe control wire 880 to the pivot 220. Pivot structures comprises anyone of a pivot hinge joint, a pivot ball and socket joint, or a pivotpin and hole joint. In some embodiments the control wire 880 is coupledto the pivot 820 through hinges located at position 860 shown in theFIG. 7. In an embodiment of the present specification, the ramp 801 isplaced between the working channel exit point 841 positioned on theproximal fluid channeling section 802 of the fluid channeling component810 and a front section 808 of the distal fluid channeling section 804as illustrated in FIG. 3A. Medical tools inserted into the workingchannel 840 from the rear portion of the fluid channeling component 810exit from the opening 841 and thereafter pass through the ramp/elevator801 in an embodiment.

In an embodiment, the control wire can be operated to regulate theposition of pivot 820 and ramp 801 in both the forward and sidewaydirections. In another embodiment, the pivot 820 is coupled to the ramp801 such that the angular position of ramp can be modified to enable themedical tools to exit at multiple angles to the long dimension of theendoscope device. According to some embodiments, the ramp 801 comprisesslightly raised structures referred as side anchoring support 830provided along an upper edge of walls of ramp 801 which guide themedical tool 801 to bend at an angle and exit the tip section through aside wall of the device. In an embodiment, the ramp 801 is in aretracted position wherein the pivot 820 is positioned substantiallyinside the wall 804 a of distal channeling section 804 of the fluidchanneling component 810 shown in FIG. 3A, FIG. 3B and FIG. 4. In thisposition the medical tool 870 exiting from the opening 841 of theworking channel 840 does not come in contact of the ramp 801 and isenabled to travel in a straight direction and exit from the frontportion of the distal tip. In an embodiment, the ramp 801 is in anextended or raised position wherein the pivot 820 is positionedsubstantially outside the wall 804 a of distal channeling section 804 ofthe fluid channeling component 810 as shown in FIG. 5A, 5B and FIG. 6.In this position, the ramp 801 and the anchoring supports 830 arepositioned such that the medical tool bends at substantially 90 degreeangle and exit the endoscope device from a side wall. While only twopositions of the ramp are discussed in detail here, the control systemdescribed for pivot 820 and ramp 801 is configured such that themovement of ramp 801 can be controlled in multiple ways, includingforward, backward, sideways, or in incremental angular shifts, to enablethe medical tool to exit at a variety of angles from either the frontportion or through a side portion /wall of the tip section of theendoscope device.

In some embodiments, movement of ramp 801 is automatically controlled bya computer program, or a pre-defined electronic signal. In embodiments,ramp 801 is adapted to operate with working channels of differentdimensions, such as and not limited to working channel diameters rangingfrom 2.3 millimeters (mm) to 7 mm. Dimensions may vary on the basis ofan application of the scope.

One of ordinary skill in the art would appreciate that the ramp 801 andthe corresponding pivot can be manufactured with any known materials oralloys which are acceptable for use in medical applications. In anembodiment the ramp and the pivot section are manufactured withstainless steel.

FIG. 4 illustrates a medical tool 870 guided by ramp 801 to exit thefront channel opening through working channel 840 in accordance withsome embodiments. As shown in the FIG. 4, the position of ramp 801 isadjusted such that a pivot coupled to the ramp 801 is largely positionedon the inside of fluid channeling component 810; as a result, ramp 801is in a position that allows the medical tool 870 to extend into theforward direction without bending. Thus, in this position, the rampallows for the medical tool to exit at an angle of substantially zerodegrees relative to the long dimension towards the front portion of thedevice. In this embodiment, the medical tool exits from the front end ofthe distal section of the endoscope assembly. In an embodiment, theposition of ramp is adjusted by the physician through a controlmechanism coupled to the handle section of the endoscope assembly asdescribed in FIG. 7. In embodiments, the angle of exit of the medicaltool 870 from the front end of the distal section is not exactly zerodegrees relative to the long dimension towards the front portion of thedevice and the ramp is enabled to exit the front end of the distal tipat an acute angle relative to the long dimension of the device dependingon the positioning and structure of working channel opening on the frontportion of the distal tip.

FIGS. 5A and 5B illustrate two different views of an alternativeposition of ramp 801, in accordance with an embodiment. In thisembodiment, the pivot 820 is configured in a raised position below ramp801. When pivot 820 is activated, it emerges from the inside wall 804 aof distal channeling section 804 of the fluid channeling component 810such that ramp 801 is raised and repositioned in a way that it guidesmedical tool 801 (referring to FIG. 6) to exit the distal portion of tipsection 800 through a side wall of the device. A side anchoring support830 provided along an upper edge of walls of ramp 801 guides the medicaltool 801 to bend at an angle and exit the tip section through a sidewall of the device. In an embodiment, the ramp 801 and the sideanchoring support 830 are adjusted such that the medical tool bends atsubstantially a 90 degree angle and exits the side wall of the of tipsection 800 in a direction perpendicular to the long dimension of theendoscope. In alternate embodiments, the positions of ramp 801 and sideanchoring support 830 can be adjusted to enable the medical device toexit at any other angle to the long dimension of the endoscope device.In an embodiment, the side anchoring support 830 is configured such thatit also provides stability to medical tool 870 during a procedure. Sideanchoring support 830 holds medical tool 870 in place and providessupport to its sides while it is inserted through working channel 840and is guided towards different directions.

Ramp 801 is controlled, in an embodiment, via pivot 820 which is used toguide or direct the exit of a medical tool 870 inserted through workingchannel 840 of endoscope assembly. The direction of medical tool 870 canbe altered such that it may exit from either front panel 820, or througha side wall of the tip section 800 of endoscope assembly. The directionof medical tool 870 may be varied between angles from zero degrees to 90degrees or more, to exit from working channel openings in the front orthe side of tip section 800. Viewing elements, such as viewing element816 on the front and viewing element 816 b on the side, provide a viewof medical tool 870 exiting in either direction.

FIG. 6 illustrates medical tool 870 guided by ramp 801 to exit from aside wall, according to some embodiments. As shown in FIG. 6, the pivot820 is activated to raise ramp 801 such that medical tool 870, afterexiting from the working channel 840, is bent and guided to exit distalpart of tip section 800 from a side wall of the endoscope device. Itshould be appreciated that, typically, a tip cover such as the tip cover300 shown in FIG. 1 covers the fluid channeling component 810 and thecircuit board 850. The medical tool 870 exits from openings provided onthe front panel or side walls of such a tip cover.

In various embodiments described in FIGS. 3A to FIG. 6, the endoscopecomprises a ramp structure that is coupled to an internal wall and canmaneuver the medical tools towards the front portion or towards a sidewall of the device. In an alternate embodiment of the presentspecification, the endoscope assembly is structured such that itcomprises two working channels similar to the working channel 840described in FIG. 3A wherein each working channel has at least oneopening on the front portion of the distal tip section and at least oneopening on the sidewall of the endoscope device . In addition, thesystem comprises a separate ramp structure for each working channel suchthat a first ramp structure enables operational access through the firstworking channel to the front portion and to one sidewall portion of theendoscope and the second ramp structure enables operational accessthrough the second ramp structure to the front portion and to theopposite sidewall portion of the endoscope device.

In another embodiment, the endoscope assembly is structured such thatthe tip section comprises a fluid channeling component comprising aworking channel with at least three exit openings. The working channelcomprises at least one opening on the front portion and at least twoopenings on the opposite sidewalls. In an embodiment, the fluidchanneling component is coupled to a ramp structure which is configuredsuch that it can be positioned in the direction of either of thesidewalls of the endoscope device and in an embodiment, it can directthe medical device inserted through the working channel to either exitfrom the front portion or exit from either of the two openings on theopposite sidewalls of the device.

The above examples are merely illustrative of the many applications ofthe system of present invention. Although only a few embodiments of thepresent invention have been described herein, it should be understoodthat the present invention might be embodied in many other specificforms without departing from the spirit or scope of the invention.Therefore, the present examples and embodiments are to be considered asillustrative and not restrictive, and the invention may be modifiedwithin the scope of the appended claims.

1-20. (canceled)
 21. A medical device assembly having a distal tipsection, the assembly comprising: an electronic assembly including aviewing element at the distal tip section; at least one fluid channel;and a working channel configured for insertion of a medical tool intoand through the distal tip section, wherein said working channelprovides: a first exit for the medical tool, said first exit comprisinga first opening in the front wall of the distal tip section; and asecond exit for the medical tool, the second exit comprising a secondopening in at least one side wall of the distal tip section; a rampstructure comprising: a ramp including a first section and a secondsection, wherein the first section includes a first planar portion thatis positioned substantially parallel to an internal wall of the distaltip section when the ramp structure is in a first position, and whereinthe second section includes a second planar portion that issubstantially perpendicular to the internal wall of the distal tipsection when the ramp structure is in the first position and in a secondposition; and a side anchoring support extending from an edge of thesecond section of the ramp and extending at an obtuse angle relative tothe second planar portion; and a pivot arm coupled to the rampstructure; and an actuator coupled to the pivot arm, wherein theactuator is configured to modify a position of the pivot arm and theramp structure, wherein the actuator is configured to transition theramp structure between the first position and the second position. 22.The medical device assembly according to claim 21, wherein the distaltip section includes a proximal fluid channeling section, a distal fluidchanneling section, and the at least one fluid channel extends throughthe proximal fluid channeling section and the distal fluid channelingsection.
 23. The medical device assembly according to claim 21, whereinthe second opening is separate from the first opening.
 24. The medicaldevice assembly according to claim 21, wherein a portion of the rampstructure is positioned proximal to the second exit.
 25. The medicaldevice assembly according to claim 21, wherein the internal wallincludes a recess configured to receive the pivot arm, the recess beingnarrower than the ramp structure.
 26. The medical device assemblyaccording to claim 25, wherein, in the first position, the pivot arm iswithin the recess, and wherein, in the second position, the pivot armprojects out of the recess.
 27. The medical device assembly according toclaim 21, further comprising a cover configured to fit over theelectronic assembly.
 28. The medical device assembly according to claim21, wherein at least a portion of the ramp structure has an L-shapedcross-section configured to hold and guide an external surface of themedical tool.
 29. The medical device assembly according to claim 21,wherein the actuator comprises a control wire coupled to the pivot armat a first end of the control wire and to a control knob positioned on ahandle section of the medical assembly at a second end of the controlwire.
 30. The medical device assembly according to claim 21, whereinwhen the pivot arm is in the second position, said medical tool exitsfrom the second exit at an angle of approximately 90 degrees relative toa central longitudinal axis of the distal tip section.
 31. The medicaldevice assembly according to claim 21, wherein said ramp structurefurther comprises a first curvilinear section and a second curvilinearsection, and wherein an edge of the first curvilinear section isconnected to an edge of the second curvilinear section to form a groovefor receiving and guiding the medical tool to either the first exit orthe second exit.
 32. A medical device assembly having a distal tipsection, the assembly comprising: a working channel configured forinsertion of a medical tool into and through the distal tip section,wherein the working channel provides: a first exit for the medical tool,said first exit comprising a first opening in the front wall of thedistal tip section; and a second exit for the medical tool, the secondexit comprising a second opening in at least one side wall of the distaltip section; a ramp structure comprising: a ramp including a firstsection and a second section, wherein the first section includes a firstplanar portion that is positioned substantially parallel to an internalwall of the working channel when the ramp structure is in a firstposition, and wherein the second section includes a second planarportion that is substantially perpendicular to the internal wall of theworking channel when the ramp structure is in the first position and ina second position; and a side anchoring support extending from an edgeof the second section of the ramp and extending at an obtuse anglerelative to the second planar portion; and a pivot arm coupled to theramp structure; and an actuator coupled to the pivot arm, wherein theactuator is configured to modify a position of the pivot arm and theramp structure, wherein the actuator is configured to transition theramp structure between the first position and the second position. 33.The medical device assembly according to claim 32, wherein the secondopening is separate from the first opening.
 34. The medical deviceassembly according to claim 32, wherein a portion of the ramp structureis positioned proximal to the second exit.
 35. The medical deviceassembly according to claim 32, wherein the internal wall of the workingchannel includes a recess configured to receive the pivot arm, therecess being narrower than the ramp structure.
 36. The medical deviceassembly according to claim 35, wherein, in the first position, thepivot arm is within the recess, and wherein, in the second position, thepivot arm projects out of the recess.
 37. The medical device assemblyaccording to claim 32, wherein at least a portion of the ramp structurehas an L-shaped cross-section configured to hold and guide an externalsurface of the medical tool.
 38. The medical device assembly accordingto claim 32, wherein the actuator comprises a control wire coupled tothe pivot arm at a first end of the control wire and to a control knobpositioned on a handle section of the medical assembly at a second endof the control wire.
 39. The medical device assembly according to claim32, wherein the ramp structure further comprises a first curvilinearsection and a second curvilinear section, and wherein an edge of thefirst curvilinear section is connected to an edge of the secondcurvilinear section to form a groove for receiving and guiding themedical tool to either the first exit or the second exit.
 40. A medicaldevice assembly having a distal tip section, the assembly comprising: aworking channel configured for insertion of a medical tool into andthrough the distal tip section, wherein the working channel provides: afirst exit for the medical tool, said first exit comprising a firstopening of the distal tip section; and a second exit for the medicaltool, the second exit comprising a second opening of the distal tipsection; a ramp including a first section and a second section, whereinthe first section includes a first planar portion that is positionedsubstantially parallel to an internal wall of the working channel whenthe ramp structure is in a first position, and wherein the secondsection includes a second planar portion that is substantiallyperpendicular to the internal wall of the working channel when the rampstructure is in the first position and in a second position; a pivot armcoupled to the ramp structure; and an actuator coupled to the pivot arm,wherein the actuator is configured to modify a position of the pivot armand the ramp structure, wherein the actuator is configured to transitionthe ramp structure between the first position and the second position.